Pneumonia

Question 1

When to roti cxray

Answer 1

If nt improving
Persisting/worsening symptoms
Underlyinh malignancy need to be excluded

Question 2

Inv in hospitalized pts

Answer 2

Blood cs
Abg if <90 and chronic lung disease
Glucose, urea. Electrolytes
Cbc lft

Severe cap- legionella

Biomarkers not advised

Question 3

Initial assessment

Answer 3

Curb 65- for hospitalization

Major/minkr criteria- icu or non icu

Question 4

Rx in opd

Answer 4

With comorbidities- azee+beta lactam

Without comorb- eithrr of them

Question 5

Non icu rx

Answer 5

Combination

If bl hsn- fq- if no tb

Question 6

Icu rx

Answer 6

No rf for pseudo- bl+fq
If pseudomonas- anti pseudpmonas
Combination- ag+anti pseud fq

Question 7

What to see if pt is not responding in 3 days

Answer 7

Cause
Dr
Atypical

Question 8

How many days rx

Answer 8

Ip’ 7
Op 5
If pseudo/gnb/aureus- longer
Abcess , meningitis, empyema

Question 9

When do ungive steroids

Answer 9

Septic shock

Ards sec to cap

Question 10

Quantitative vs semi Quantitative

Answer 10

Equally useful

Invasive lrt sample is preffered

Question 11

How do u give abx in hap/vap

Late onset

Answer 11

By hospital flora
Late onset- combination therapy-mdr
Change later acc to c/s
Initial -Colistin not recommended

Question 12

How do u deescalate in vap

Answer 12

If positive culture, next sample sterile
Abx for 7 days
Cpis on day 7 - if less than 6 stop
More than 6- continue 10-14 days

Question 13

Inhaled abx

Answer 13

Aersoloized as adjunctive when mdr and toxicity is concern

Not as monotherapy

Question 14

Ventilator ass trachea bronchitis

Answer 14

No rx required

Question 15

When linezolid is used

Answer 15

Renal failure
Vanco intolerant
Resistance

Doc mrsa- vanco/ teico

Question 16

Rx of acinetobacter mdr

Answer 16

Carbopenem

Coniston

Question 17

Mdr pseudomonas

Answer 17

Combined carba+fq/ag

Question 18

Systemic features

Answer 18

Fever
Chills and rigors
Malaise

Question 19

Diagnosis of cap

Answer 19

Resp symptoms
One systemic feature
New focal chest sign
No other explanation

Question 20

Algorithm for cap

Answer 20

Xray- consolidation absent - other diagnosis
Plus- curb 65
Less than 1 - spo2 92 and 90 in 50 less and more age respectively
If less ipd
If normal opd

Question 21

Hap criteria

Answer 21

Chest radio opacities (new, progressive,  persistent , cavity)
2 of following- fever 100.4
Tlc 12000 4000
Sensorium
Sputum purulent or change
Worsening gas exchange 
New onset cough/dyspnoea/ tachy/ rales

Question 22

What to do if not improving in hap

Answer 22

If positive culture 
Change abx
Snes- dosing
New infection 
Complication- empyema, abcess
Non infective caus

If negative- roti cultures, fungal
Other sources if sepsinon infectious causes

Question 23

Curb 65

Interpretation

Answer 23

0-1 home mx
2- admission vs close opd
3-5 admission

Confusion
Urea 7 20
Rr 30
BP 90/60
!)age 65

Question 24

Interpretation of crb 65

Answer 24

Less than 1- opd

More ‘- ipd

Question 25

Other criterias

Answer 25

``` Smart cop Cop Cap-piro Rea-icu A-drop ```

Question 26

Major criteria | Minor

Answer 26

Imv/vasopressors ``` Rr30 Fao2/fio2- less than 250 Multi lobar Confusion Uremia Tlc lesz than 4000 Thrombocytopenia 1 lakh Hypothermia less than 36 ```

Question 27

Psi

Answer 27

``` Demographics Comorbs Physical exam Labs Total 20 variables ``` <70- opf More than 90- ip

Question 28

Early onset vap | late onset vap

Answer 28

4 days

Question 29

R/f for mdr bacteria

Answer 29

Hospitalization more than 5 days Antibiotics in 3 months Resistance in hospital Wound care/ dialysis/ is drugs

Question 30

Gnb in hap/vap

Answer 30

Pseudo E coli Kleb Acineto

Question 31

Objective bed side criteria fir hap/vap

Answer 31

Modified cpis ``` Secretions Infiltrates Temp Leukocytes Temp Pao2/fio2 ratio Micro Morethan 6- pneumonia ```

Question 32

Biomarkers in vap

Answer 32

Strem 1 Pct Crp

Question 33

Empiric therapy for late onset

Answer 33

One of anti pseudomonas pen/ 3or4th gen ceph/ carbapebem Plus ag or fq(cipro/levo) Mrsa cover- if high prevalence

Question 34

Def of vat

Answer 34

Temp Leukocytosis/ penia Secretions inc - without radiology deteroiation

Question 35

Risk dlfactors for mrsa/pseud

Answer 35

Prior isolation Recent hosp Iv abx in lSt 30 days

Question 36

When do u give anaerobic coverage

Answer 36

Only in abcess/empyema

Question 37

Prevention

Answer 37

``` Oral decontamination Hand hygiene Closed auction Niv Echanger Cuff p less than 25 Elevation ```

Question 38

Idsa

Answer 38

Non severe ip Standard- bl+macro/fq Prior isolation of paeud/ mrsa- add and wait for cultures Recent hosp/ r/f - cultures and wait Severe- same but add coverage if risk factors plus

Question 39

Crp

Answer 39

Less than 3 normal More than 10 infection. 3-10 - various

Question 40

Vap bundle

Answer 40

``` Hob elevation Sedation vacation Assessment to extubate Ulcer prophylaxis Dvt prophylaxis ```